Scarcity of meningitis vaccine persists as epidemic worsens

*Emergency Operations Centre shuts down for Easter holidays

Nigeria may not be able to get enough vaccines to prevent the spread and fatality of the ongoing Cerebro Spinal Meningitis (CSM) type C. Nigeria urgently needs 1.3 million doses of vaccines for meningitis type C strain but has taken delivery of only 500,000 doses.

Why? According to the World Health Organisation (WHO), most vaccines currently being used for meningitis C outbreaks in Africa are polysaccharide vaccines, which are in short supply as they are being phased out in other parts of the world and the more effective and long-lasting conjugate vaccines, however, are not readily accessible for outbreak response in the region.

The WHO said the International Coordinating Group (ICG) on Vaccine Provision global emergency stockpile currently has approximately 1.2 million doses of meningitis C-containing vaccines left.

WHO meningitis expert, Dr. Olivier Ronveaux, said: “The very limited supply of vaccines to control outbreaks of meningitis C can affect our ability to control these epidemics. In the long term, the accelerated development of affordable and effective conjugate vaccines to cover all epidemic types of meningitis is a high priority for WHO and partners.”

Another constraint to the vaccines availability is the cost of the vaccines, which is $50 per dose. So Nigeria needs N396 billion to vaccinate the recommended 22 million people aged between one and 29 years-old.

Also, the Emergency Operations Centre (EOC) set up under the mandate of the Minister of Health, Prof. Isaac Adewole, to support effective outbreak response coordination across the entire country, has reneged on its promise of giving situation report of the CSM epidemic every Friday.

The Guardian reliably gathered that the number of suspected cases has spread beyond 5,000 and 500 deaths across more than 19 states. Adewole had mandated the Nigeria Centre for Disease Control (NCDC) to activate an EOC, which had swung into action. The Centre is currently staffed with experts from the NCDC, National Primary Health Care Development Agency (NPCHDA), the Federal Ministry of Health (FMoH) and others from the United States Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), United Nations Children Fund (UNICEF) and other partner agencies.

But unlike the previous three weeks, the EOC did not give any update to the media and Nigeria public last Friday April 14, 2017, on the epidemic. When The Guardian contacted the centre, it was learnt that they had to postpone the date of the release of the situation report because of the Eater holidays.

The Incident Manager, Dr. John Oladejo, had told journalists: “Our work here is to put in place a sustainable process for responding to the current Meningitis Outbreak. We are happy to say that this is truly a partnership focused on successfully stopping the outbreak. We will work round the clock to implement rapid response plans and deal with emerging issue.

“We acknowledge the several media requests, we will continue to work hard on granting as much as we can. You may however look forward to our press release every Friday and we will do our best to ensure it is as comprehensive as possible. We are also open to recommendations you may reach me through my direct line 08060969057 or email address.”

According to the WHO, in the last week, the ICG, which is managed by the International Federation of Red Cross and Red Crescent Societies (IFRC), Médecins sans Frontières (MSF), the United Nations Children’s Fund (UNICEF), and WHO, has also sent 341 000 doses of the Global Vaccine Initiative (Gavi)-supported meningitis C-containing vaccine to Niger, where there are over 1300 suspected cases of the disease in districts that border with Nigeria and in the Niamey region of the country.

In addition to the use of vaccinations to prevent the transmission of meningitis, 20 000 vials of antibiotics have been sent by the ICG to treat people who have the disease in Nigeria.

Director of Infectious Hazard Management for WHO, Dr. Sylvie Briand, said: “Vaccination can drastically reduce the magnitude of the epidemic. But in addition, it is essential to strengthen the care of all those affected by the infection and to ensure those people living in hard-to-reach areas can get treatment.”

The NCDC, with support from WHO, US CDC, UNICEF and other partners, is leading and coordinating the response to the ongoing outbreak, including intensified surveillance, capacity building for case management and risk communication. WHO’s Country Office in Nigeria, including a number of field offices, have been supporting the government since the outbreak began. An additional team of WHO of meningitis experts has arrived in Nigeria to provide additional epidemic response.

WHO Representative to Nigeria, Dr. Wondimagegnehu Alemu, said: “In addition to improving the care of the sick, we are focusing on ensuring accurate information about the spread of the outbreak is available as quickly as possible to help us make the most effective use of vaccines.”

Meningococcal meningitis is a bacterial form of meningitis, a serious infection of the thin lining that surrounds the brain and spinal cord and can cause severe brain damage. Meningococcal meningitis is fatal in 50 per cent of cases if untreated. Though cases of meningitis occur throughout the world, large, recurring epidemics affect an extensive region of sub-Saharan Africa known as the “meningitis belt” which includes 26 countries from Senegal in the west to Ethiopia in the east.

There are several different types of meningococcal meningitis (A, C, W, etc.) that can cause epidemics. Substantial progress has been made in recent years in protecting Africa from disease due to one of the main epidemic types, through the successful introduction of the Men A conjugate vaccine (MACV) against meningitis A. Since MACV was introduced in 2010, more than 260 million people have been vaccinated across 19 countries. This has resulted in a reduction of the number of meningitis cases by more than 57 per cent. Much work, however, remains to be done to protect the region from meningitis C outbreaks and other types of the disease.